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PT3 Oncology > colon and lung > Flashcards

colon and lung Flashcards

(55 cards)

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1
Q

colon cancer risk

A

1 in 25

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2
Q

colon cancer growth rate

A

slow

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3
Q

risk factors of colon cancer

A
  • Family history 20%
  • IBD
  • lifestyle factors
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4
Q

life style risk factors for colon cancer

A
  • smoking
  • red/processed meats
  • alcohol
  • low physical activity
  • high BMI
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5
Q

age to start colon cancer screening if no risk factors

A

50

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6
Q

age to start colon cancer screening if FHx positive

A

40 or 10 years prior to relatives diagnosis

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7
Q

age to start colon cancer screening if HNPCC

A

20-25

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8
Q

age to start colon cancer screening if FAP

A

puberty, 10-12

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9
Q

age to start colon cancer screening if UC or CD

A

8 years after onset

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10
Q

two types of screening tools for colon cancer

A
  • flexible sigmoidoscopy

- total colonoscopy

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11
Q

flexible sigmoidoscopy features

A
  • removes polyps
  • 20 mins
  • no sedation
  • only examines 60% of colon
  • no biopsy
  • less bowel prep
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12
Q

total colonoscopy features

A

-examines whole bowel
-removes polyps
-can biopsy
-not as cost effective
invasive
-intense bowel prep

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13
Q

factors that lead to mutation in colon cancer development

A
  • activation of Wnt
  • activation of EGFR and oncogenes
  • inactivation of tumor suppressors
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14
Q

most common sites of metastasis for colon cancer

A

in order:

  • liver
  • lung
  • bone
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15
Q

staging work up needed for colon cancer

A
  • CT or MRI
  • diagnostic colonoscopy
  • CBC and CMP
  • genetic testing
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16
Q

important genetic tests for colon cancer

A
  • Ras
  • micro-satellite instability
  • mismatch repair

-UGT1A1

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17
Q

curable stages of colon cancer

A

stage 1 - 3B

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18
Q

general treatment for stage 0 and 1 colon cancer

A

surgery

surveillance

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19
Q

general treatment for stage 2 colon cancer

A

surgery

adjuvant chemo?

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20
Q

general treatment for stage 3 colon cancer

A

surgery?

adjuvant chemo

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21
Q

general treatment for stage liver only metastasis in colon cancer

A
  • chemoembolization
  • hepatic arterial infusion chemo
  • surgery?
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22
Q

general treatment for stage 4 colon cancer

A
  • palliative chemo

- surgery/radiation?

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23
Q

treatment of choice for stages 1-3 of colon cancer

24
Q

what drug do we need to check UGT1A1 for

25
adjuvant chemo for stage 3 colon cancer
5-FU/leucovorin
26
adjuvant chemo options for high risk stage 3 or palliative colon cancer
- FOLFOX +/- bevacizumab - FOLFOX +/- cetuximab/panitumumab - CAPEOX +/- bevacizumab - FOLFIRI + cetuximab/panitumumab
27
duration of therapy for high risk stage 3 colon cancer
6 months
28
duration of therapy for metastatic colon cancer
until progression or intolerance to therapy
29
if patient progressed through FOLFOX and FOLFIRI OR can't tolerate intense therapy, what can we use
- MIS, MMR therapy | - PD-1 therapy (nivolumab/ pembrolizumab)
30
drugs in mFOLFOX 6 + beva regimen and cycle length
-leucovorin -oxaliplatin -5-FU push and cont. -Beva 14 day cycle, 12 cycles
31
unique toxicity from oxaliplatin
laryngeal spasms when drinking something cold
32
how leucovorin works in colon cancer
helps 5-FU bind and stay bound to thymidylate synthase
33
monitoring for FOLFOX + Bev
- bone marrow, especially platelets - renal/hepatic function - neurologic effects - vascular - VTE - wound healing
34
minimum time between bevacizumab treatment and surgical procedures
28 days due to reduced healing
35
side effects for FOLFOX + bevacizumab
- fatigue - N/V/D - infection - laryngeal spasm/neuropathy - bruising, bleeding, clotting
36
lifetime risk of lung cancer
1 in 15
37
workup and staging of lung cancer
- Hx and physical - symptoms (coughing blood) - cbc/cmp - PET-Ct or MRI - biopsy - ECOG
38
ECOG scale for lung cancer
``` 0 = fully active 1 = restricted from strenuous activity, can do light work 2 = up and about >50% 3 = in bed or chair > 50% 4 = completely disabled 5 = dead ```
39
ECOG scores we're willing to treat aggressively
0-2
40
general types of lung cancer
- non-small cell lung cancer | - small cell lung cancer
41
characteristics of small cell lung cancer
- fast doubling time - high growth fraction - early development of metastasis - highly correlated with smoking - no effective means to screen
42
most pts diagnosed with SCLC are in which stage
stage 4
43
upside of treating SCLC
- responsive to chemo - responsive to radiation - substantial improvement in QoL
44
downside of treating SCLC
- metastasis has usually already occurred - after initial treatment its usually resistant - abnormal secretions (ACh, prothrombotics)
45
treatment plan for limited stage SCLC
chemo and radiotherapy to chest
46
treatment plan for extensive stage SCLC
chemo alone
47
chemo treatment for SCLC including cycle
etoposide and cisplatin/carboplatin | 21 day cycle, 6 cycles
48
characteristics of non-small cell lung cancer
- moderate doubling time - low growth fraction - early development of metastasis - highly correlated with smoking - no effective means to screen
49
staging of SCLC
1-3 confined to ipsilateral hemithorax | 4 beyond ipsilateral hemithorax
50
staging of NSCLC
1 - localized 2 - localized w/lymph 3 - invasion through lung 4 - distant spread
51
chemotherapy strategy for early stage lung cancer
doublet therapy
52
chemotherapy strategy for metastatic NSCLC
if we have agents that can be used for targeted therapy use the otherwise doublet therapy if they can tolerate
53
doublet therapy regimens for NSCLC
- cisplatin + paclitaxel or gemcitabine or docetaxel | - carboplatin + paclitaxel
54
mutations important in treatment of NSCLC
ALK ROS1 KRAS BRAF
55
oncogene addiction
mutations that drive the neoplastic phenotype

PT3 Oncology (9 decks)

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